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General NPI Number Information
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NPI Number | 1134726672
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Entity Type | Organization
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Legal Business Name | LA BELLA VIDA LLC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 3620 WYOMING BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3297
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Country | US
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Telephone | 505-489-4003
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Fax |
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Provider Business Mailing Address
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Address Line | 2561 SANDIA LOOP NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-7516
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Country | US
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Telephone | 505-489-4003
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SELINDA TURNER
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Credential |
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Telephone | 505-489-4003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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